A Case of Anesthesia of Subtotal Gastrectomy for Gastric Cancer in a Paraquat-Poisoned Patient

Twenty-four hours after oral ingestion of paraquat, a 67-year-old female was admitted to have hemodialysis, direct hemoperfusion and steroid pulse therapy. During the intensive care, a gastric cancer which required an early radical operation was diagnosed. The minimum requirement for anesthesia was regarded as 1) negative qualitative paraquat urinalysis, 2) normalization of the serum peroxide lipid level, and 3) restoration and stabilization of the arterial blood gas level. On the 53rd day of hospitalization, the patient satisfied above mentioned requirements for anesthesia and subtotal gastrectomy was performed. Some attempts at anesthetic management were 1) normoxic ventilation keeping FIO2 in 0.21-0.22 to prevent lung fibrillation, 2) no use of N2O to prevent enlargement of pulmonary bulla which the patient already had right after ingestion of paraquat and 3) epidural anesthesia supplement by droperidol and fentanyl. No complications occurred in intra- or post-operative course of management.